Musculoskeletal Function and Assessment

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is caring for a patient who had a bone biopsy on the right leg. Which activity should the nurse implement?
a. Ambulate twice daily.
b. Monitor site of biopsy for bleeding.
c. Perform hourly passive range of motion.
d. Perform active range of motion every 2 hours.
____ 2. The nurse is caring for a patient 1 hour after a diagnostic arthroscopy of the right knee. Which activity should the nurse implement?
a. Strict bedrest
b. Straight-leg raises
c. No weight-bearing on right leg for 3 days
d. Partial weight-bearing on left leg for 1 week
____ 3. The nurse, who is inspecting the knee of a patient who fell and reports stiffness, hears a grating sound with knee movement. How should the nurse document this finding?
a. Arthritis
b. Crepitus
c. Synovitis
d. Inflammation
____ 4. The nurse is gathering functional data on a patient with rheumatoid arthritis. Which of these areas should be included?
a. Ability to dress
b. Muscular build
c. Nutritional status
d. Height and weight
____ 5. A patient recovering from a bone biopsy of the left leg has pain unrelieved by morphine 5 mg intramuscularly given 1.5 hours ago. The morphine is prescribed for every 3 hours. What should the nurse do?
a. Elevate the extremity.
b. Repeat morphine now.
c. Notify the charge nurse.
d. Administer morphine in 30 minutes.
____ 6. The nurse is caring for a patient with a suspected bone tumor. Which serum laboratory result indicates to the nurse that this health problem is present?
a. Decreased calcium
b. Increased magnesium
c. Increased creatine kinase
d. Elevated alkaline phosphatase
____ 7. An older adult visiting a wellness clinic reports joint stiffness in the morning. What should the nurse respond to this patient?
a. “The stiffness is due to decreased moisture in joint bones.”
b. “As we age, the cartilage in joints gets rough, causing stiffness.”
c. “The fluid in your joints gets thinner as you age, so your joints get stiff.”
d. “The body makes extra synovial fluid as we age, and that makes joints stiff.”
____ 8. The nurse is collecting data for a patient who is reporting pain in the hand joints. What question should the nurse ask to determine the quality of the pain?
a. “Does the pain move?”
b. “How does the pain feel?”
c. “Did an event cause the pain?”
d. “How would you rate the pain?”
____ 9. The nurse is collecting data for a patient who is reporting pain in the right hip. Which question should the nurse ask to determine the severity of the pain?
a. “Is the pain burning?”
b. “Is the pain throbbing?”
c. “Does the pain radiate or move around?”
d. “What number rating would you give your pain on a scale from 0 to 10?”
____ 10. The nurse is collecting data for a patient who is reporting pain in the left knee. What question should the nurse ask to address radiation of the pain?
a. “Is the pain intense?”
b. “Is the pain burning?”
c. “Does the pain move?”
d. “How would you describe the pain?”
____ 11. The nurse is collecting data for a patient who is reporting pain in the left wrist. What question should the nurse use to address the region of the pain?
a. “Is the pain mild?”
b. “Where is the pain?”
c. “Does the pain move?”
d. “How does the pain feel?”
____ 12. The nurse is caring for a patient scheduled for an arthrography. What should the nurse explain to the patient about pain expectations during the procedure?
a. “There is no pain during the procedure.”
b. “There is pain while the x-ray is taken.”
c. “There is temporary pain during dye injection.”
d. “The procedure will be uncomfortable until it is completed.”
____ 13. The nurse is reinforcing teaching for a patient who has severe arthritis and is having an x-ray. Which patient statement indicates teaching has been effective?
a. “The table is hard and cold.”
b. “I may move during the x-ray.”
c. “A soft mattress covers the table.”
d. “I may lie in a position of comfort.”
____ 14. The nurse is collecting data on a patient with a crushing injury to the lower extremities.
Which serum creatine kinase (CK) result should the nurse review and report to the physician?
a. CK-MB
b. CK-MM
c. CK-BB
d. CK1
____ 15. The nurse is collecting data for a patient with osteoporosis. Which serum calcium result indicates the typical changes that occur in serum calcium levels with osteoporosis?
a. 6.5 mg/dL
b. 8.9 mg/dL
c. 9.7 mg/dL
d. 11.2 mg/dL
____ 16. A patient scheduled for a magnetic resonance imaging (MRI) scan of the abdomen and pelvis asks how the machine takes a picture. What should the nurse respond to the patient?
a. “Magnetic fields create an image.”
b. “Sound waves bounce off your organs to create the picture.”
c. “Heat energy from the molecules of your body is detected to create a picture.”
d. “X-rays from multiple angles are passed simultaneously to get a three-dimensional image.”
____ 17. The nurse is reinforcing teaching provided to a patient scheduled for an arthrocentesis. Which patient statement indicates understanding of the planned procedure?
a. “They will use a small camera to look inside the joint.”
b. “They will inject dye that shows up on a special camera.”
c. “I’ll be in a closed tube while they take pictures of my arm.”
d. “A needle will be used to draw off some fluid from my elbow.”
____ 18. The nurse is caring for a patient who is to have a needle biopsy of a tumor in the right calf. Which patient statement indicates correct understanding of the teaching?
a. “I will need a few stitches.”
b. “I will need a spinal anesthetic.”
c. “The biopsy is usually taken with fluoroscopy.”
d. “The biopsy will be used to determine if this is a cancerous tumor.”
____ 19. A patient is experiencing sacroiliac joint pain after falling. Which structure within the vertebral column should the nurse suspect is injured in this patient?
a. Axis
b. Atlas
c. Sacrum
d. Coccyx
____ 20. A patient is suspected as having a fractured skull. When explaining this pathology to the patient, how should the nurse describe the joints between the cranial bones?
a. Pivot
b. Saddle
c. Gliding
d. Sutures
____ 21. The nurse is assessing capillary refill time for a patient with a fractured tibia and fibula. Which refill time should the nurse report to the physician?
a. 2 seconds
b. 3 seconds
c. 5 seconds
d. 7 seconds
____ 22. A patient with a neurological illness has lost the function of opposing muscle antagonists. What should the nurse expect to assess in this patient?
a. Steady cursive handwriting
b. Perfect diction when talking
c. Inability to maintain balance
d. Intact gag and corneal reflexes
____ 23. A patient is diagnosed with fractured thoracic vertebrae from a motor vehicle crash. Which other structure should the nurse suspect may have been damaged during this accident?
a. Ribs
b. Liver
c. Heart
d. Lungs
____ 24. The daughter of an older female patient with osteoporosis asks what she can do to prevent the development of the disorder as she ages. What should the nurse suggest to the daughter?
a. Keep body weight low.
b. Increase oral intake of calcium.
c. Engage in water aerobic activities.
d. Engage in weight-bearing exercises.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 25. A patient recovering from a biopsy of the right femur had pain medication 1 hour ago. Which symptom should the nurse report and closely monitor in this patient? (Select all that apply.)
a. Temperature 98.4°F
b. Hematoma formation
c. Capillary refill of 3 seconds
d. Pain reported as 7 on a 0-to-10 scale
e. Range of motion of the ankle and knee present
____ 26. A patient with diabetes mellitus is scheduled for an arthroscopy of the right knee at 0800. What should be included in nursing preoperative care for this patient? (Select all that apply.)
a. Maintaining NPO (nothing by mouth) status
b. Obtaining blood glucose
c. Providing a liquid breakfast
d. Explaining the anesthetic agents
e. Reviewing the surgical procedure
f. Witnessing signature on surgical consent
____ 27. A patient was an unrestrained passenger in a motor vehicle accident and hit the windshield. The patient’s leg was also fractured. Which areas should be included in a patient’s neurovascular checks? (Select all that apply.)
a. Pulses
b. Sensation
c. Movement
d. Orientation
e. Pupil reaction
f. Level of consciousness
____ 28. A patient is experiencing a tendon that is torn from a moveable bone. What should the nurse observe when collecting data on the patient’s musculoskeletal system?
a. Inability to move the joint
b. Hyperflexion of the joint
c. Hyperextension of the joint
d. Crepitus and palpable nodules
____ 29. A patient in a motor vehicle crash has injuries to bones of the appendicular skeleton. Which bones should the nurse expect to support when caring for this patient? (Select all that apply.)
a. Skull
b. Femur
c. Hyoid
d. Rib cage
e. Humerus
____ 30. The nurse is admitting an 88-year-old woman to an extended care facility. Which findings should the nurse consider as normal age-related changes of the patient’s musculoskeletal system? (Select all that apply.)
a. Limb weakness
b. S-shaped curve to back.
c. Loss of 2 inches in height
d. Walks with small, shuffling steps.
e. Mild pain experiencing in the hands during the morning hours
____ 31. The mother of a 6-year-old child is concerned that the child is not going to be tall like other family members. What should the nurse explain as influencing the growth of bone? (Select all that apply.)
a. Reduced levels of insulin
b. Limited amounts of thyroxine
c. Adequate intake of vitamin D
d. Production of growth hormone
e. Adequate intake of vitamins A and C
____ 32. The nurse is collecting data for a patient’s health history as part of the musculoskeletal system assessment. What should the nurse include when collecting this data? (Select all that apply.)
a. Diet history
b. Occupation and activities
c. Cardiovascular and respiratory problems
d. Risk factors for musculoskeletal problems
e. Family history of musculoskeletal problems
Other

33. The nurse is explaining muscle function to a group of high school students during Health Class. In which order should the nurse discuss the neuromuscular junction? Place the steps 1 through 6 in order.
A.___ Neuron releases acetylcholine.
B.___ Myosin shortens the sarcomeres and pulls the muscle fiber.
C.___ Calcium from the sarcoplasmic reticulum bonds to myosin heads.
D.___ Action potential travels down motor neuron to the synaptic end bulb.
E.___ Action potential travels into the transverse tubules to the sarcoplasmic reticulum.
F.___ Acetylcholine crosses into the synaptic cleft and bonds with receptors on motor end plate.

Chapter 45. Musculoskeletal Function and Assessment
Answer Section

MULTIPLE CHOICE

1. ANS: B
After a bone biopsy the site should be monitored for bleeding. A. Ambulating may be indicated after it is determined that bleeding is not occurring at the site. C. D. Active or passive range of motion exercises should not be done until it is determined that bleeding will not occur at the site.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

2. ANS: B
If the patient had a diagnostic arthroscopy and no surgical repair, the nurse should encourage the patient to exercise the leg, including straight-leg raises. A. Strict bedrest is not indicated. C. D. The patient can resume regular activities in 24 to 48 hours.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

3. ANS: B
Crepitation is a grating sound as joint or bone moves. A. There is not enough information to determine if the patient has arthritis. C. Synovitis is an inflammation of synovial fluid within a joint. D. Inflammation would cause a joint area to feel warm, painful, and edematous.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

4. ANS: A
Rheumatoid arthritis may make it difficult to perform activities such as dressing. Observe the patient’s range of motion for performing independent activities of daily living. Pay particular attention to the hands, and observe movement in finger joints. B. C. D. Muscular build, height and weight, and nutritional status do not provide information about the patient’s functional status.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

5. ANS: C
The nurse should notify the charge nurse because the patient needs pain relief and cannot wait 2 hours. An assessment should be done to determine the cause of the pain as increased pain that is unresponsive to analgesic medication may indicate bleeding in the soft tissue. A. Elevating the extremity might help however the patient needs additional pain medication. B. C. The nurse cannot provide the pain medication now or in 30 minutes because the order is written for the medication to be provided every 3 hours.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

6. ANS: D
Alkaline phosphatase (ALP) is an enzyme that increases when bone or liver tissue is damaged. In metabolic bone diseases and bone cancer, ALP increases to reflect osteoblast or bone-forming cell activity. A. Serum calcium tends to decrease in patients with osteoporosis or in people who consume inadequate amounts of calcium in their diets. Serum calcium levels increase in patients with bone cancer. B. Magnesium is not an identified laboratory test to monitor for this patient. C. Creatine kinase is monitored for muscle disease.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

7. ANS: B
After many years, articular cartilage wears down and becomes rough, leading to pain and stiffness. A. The stiffness is not due to decreased moisture in the bones or joints. C. The stiffness is not due to thinning of fluid in the joints. D. Synovial fluid does not increase with aging. Additional synovial fluid would not make joint stiffer.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

8. ANS: B
Asking how the pain feels would help identify the quality of the pain. C. Asking if an event caused the pain helps identify a triggering event. A. Asking if the pain moves assesses for radiation of pain. D. Asking the patient to rate the pain determines the severity using a rating scale.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

9. ANS: D
Asking the patient to rate the pain on a scale from 0 to 10 determines the severity of the patient. A. B. Asking if the pain is burning or throbbing determines the quality of the pain. C. Asking if the pain moves determines radiation of pain

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

10. ANS: C
Asking if the pain moves assesses for radiation. B. D. Asking if the pain burns or for the patient to describe the pain determines the quality of the pain. A. Asking if the pain is intense determines the severity.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

11. ANS: B
Asking “where is the pain” determines the region. C. Asking if the pain moves determines pain radiation. A. Asking if the pain is mild determines pain severity. D. Asking how the pain feels determines the quality of the pain.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

12. ANS: C
Inform the patient that the test is uncomfortable during injection. A. There is pain during the injection so this statement would not be true. B. The pain will be diminished by the time the x-ray is taken. D. The entire procedure will not be uncomfortable.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

13. ANS: A
Inform patients that they will have to lie still during the examination and that the x-ray table will be cold and hard. B. The patient will not be able to move during the x-ray. C. A soft mattress is not on the x-ray table. D. The patient will be placed into positions that best visualize the area being x-rayed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

14. ANS: B
When muscle tissue is damaged, a number of serum enzymes are released into the bloodstream, including skeletal muscle creatine kinase (CK-MM [CK3]). A. C. D. These creatinine kinase tests measure muscle tissue damage for other body organs.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

15. ANS: A
Serum calcium tends to decrease in patients with osteoporosis or in people who consume inadequate amounts of calcium in their diets. A. B. Normal serum calcium levels are 8.5 to 10.5 mg/dL. D. Calcium, levels greater than 10.5 mg/dL indicate hypercalcemia which may be related to metastatic bone disease or extended immobilization.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

16. ANS: A
For an MRI electromagnets provide a three-dimensional visualization of the area. B. C. D. An MRI is not conducted with sound waves, heat energy, or x-rays.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

17. ANS: D
Arthrocentesis involves withdrawal of synovial fluid from a joint space. It is used for analysis of the synovial fluid or for reduction of excess fluid. A. This describes arthroscopic surgery. B. This describes a CT scan with contrast. C. This describes an MRI or CT scan.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

18. ANS: D
Bone or muscle tissue can be surgically extracted for microscopic examination to confirm cancer, infection (bone biopsy), inflammation, or damage (muscle biopsy). Two techniques are used to retrieve muscle tissue: a needle (closed) biopsy or an incisional (open) biopsy. A. The patient may or may not have stitches from the biopsy. B. A surgical anesthetic is not required for the biopsy. C. Fluoroscopy is not used during a muscle biopsy.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

19. ANS: C
The sacrum articulates with the os coxae at the sacroiliac joints. B. The atlas is the first cervical vertebrae. A. The axis is the second cervical vertebrae. D. The coccyx serves as an attachment point for some muscles of the perineum.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

20. ANS: D
All of the joints between the cranial bones and those between most of the facial bones are immovable joints called sutures. A. Pivot joints are rotational and are found at the atlas and axis of the neck. B. Saddle joints move in several planes such as those of the thumb. C. Gliding joints move side-to-side such as those of the wrists.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

21. ANS: D
When assessing a patient with a fractured tibia and fibula, the nurse should report to the physician if the capillary refill time is greater than 3 to 5 seconds, as it can indicate circulatory compromise. A. B. C. These are all normal capillary refill times.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

22. ANS: C
There are approximately 700 skeletal muscles in the body. The general type of arrangement is the agonist with opposing antagonists and the cooperative synergists. Without synergism, maintaining balance would be difficult. A. B. Without synergism having fine motor control for writing or talking would be difficult if not impossible. D. Gag and corneal reflexes are not contingent upon the function of opposing muscle antagonists.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

23. ANS: A
The thoracic vertebrae articulate with the posterior ends of the ribs. A. C. D. The liver, heart, and lungs are protected by the thoracic cage.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

24. ANS: D
The bone loss from osteoporosis can be offset by weight-bearing physical exercise which stimulates bone matrix deposition, increasing bone density. A. Keeping body weight low does not necessarily reduce the risk of developing osteoporosis. B. Increasing the oral intake of calcium should be determined by the daughter’s primary care provider. C. Water aerobic activities are not weight-bearing and will not prevent the development of osteoporosis.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

MULTIPLE RESPONSE

25. ANS: B, D
The nurse inspects the biopsy site for bleeding, swelling, and hematoma formation. Increased pain that is unresponsive to analgesic medication may indicate bleeding in the soft tissue. A. This is a normal body temperature. C. This is a normal capillary refill. E. Full range of motion is an expected finding.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

26. ANS: A, B, F
The nurse should witness signature on the surgical consent, maintain NPO status, and check the blood glucose level. C. The patient is to take nothing by mouth. D. E. The physician is responsible for completing these actions.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

27. ANS: A, B, C
Neurovascular checks for an extremity include movement, sensation (numbness/tingling), presence of pulses, skin temperature, color, and capillary refill. D, E, F. Orientation, pupil reaction, and level of consciousness are neurological checks that are done to monitor the central nervous system.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

28. ANS: A
A muscle usually has at least two tendons, each attached to a different bone. The more stationary muscle attachment is called its origin; the more movable attachment is the insertion. The muscle itself crosses the joint formed by the two bones to which it is attached, and when the muscle contracts, it pulls on the insertion moving the bone in a particular direction. The muscle causing this particular action is termed the agonist. If the movable muscle is torn, the joint will not be able to be moved. B. C. These movements would necessitate the movable tendon to be intact and attached. D. Crepitus and palpable nodules occur within a joint and not at the site of muscle insertion into a bone.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

29. ANS: B, E
The appendicular skeleton consists of long bones including the femur and humerus. A. C. D. The axial skeleton consists of the skull, hyoid, and rib cage.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

30. ANS: A, C, E
Common age-related changes include decreased height due to smaller intervertebral spaces; joint pain and stiffness are associated with articular cartilage wear; and limb weakness because muscle strength declines with age as protein synthesis decreases. D. Small shuffling steps may be seen with Parkinson’s disease. B. S-shaped curve is usually related to scoliosis.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

31. ANS: C, D, E
The growth of bone from fetal life until final adult height depends on many factors. Vitamin D is essential for the efficient absorption of calcium and phosphorus in the small intestine. Vitamins A and C are required for the production process of bone matrix. GH increases mitosis and protein synthesis. A. Insulin is essential for the efficient use of glucose to provide energy. B. Thyroxine stimulates osteoblasts and also increases energy production. If a child is lacking any of these hormones, growth is slower and the child may not reach his or her genetic potential for height.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

32. ANS: A, B, D, E
The patient’s history should include diet history to determine if calcium and vitamin D intake are adequate, occupation and activities including sports and other physical activities, risk factors for musculoskeletal problems and family history of musculoskeletal problems to detect hereditary factors. C. Cardiovascular and respiratory problems are not a part of the health history for the musculoskeletal system.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

OTHER

33. ANS:
A, D, F, E, C, B
The neuron releases the neurotransmitter, acetylcholine (Ach), which signals muscle contraction. An action potential travels along the motor neuron, reaching the synaptic end bulb. Acetylcholine is exocytosed into the synaptic cleft and bonds with receptors on the motor end plate. An action potential initiates and travels along the sarcolemma and into the transverse tubules, transferring to the sarcoplasmic reticulum. Calcium ions released from the sarcoplasmic reticulum bond to troponin of the thin filament, exposing bonding sites on actin for myosin heads. Myosin of the thick filament attaches and pulls the thin filament, shortening the sarcomeres and thus the muscle fiber.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application